Berwick House is located in a residential area of South Shore Blackpool. The home is registered to accommodate up to 24 people who require assistance with personal care. At the time of our inspection there were 23 individuals who lived at the home. The property has garden areas to the front and rear of the building. There are a range of aids and adaptations to meet people’s needs. Accommodation is available over two floors with lift access to the upper floor.

At the last inspection on 01 June 2016, the service was rated good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection visit, we found there were sufficient staffing levels and skill mixes to meet people’s requirements. People and their relatives said staff took their time and were calm and patient. One person stated, “Yes, there’s always staff about.” They said this helped them to feel safe and secure at Berwick. When we discussed safeguarding vulnerable adults from the risk of harm or abuse with staff, we found they had a good understanding.

The registered manager had multiple environmental procedures and auditing systems to ensure the continued safety of those who lived at Berwick. They provided guidance for staff to assess and mitigate the risk of unsafe or inappropriate care.

People who lived at Berwick and their relatives told us staff managed their medication safely and administered them on time. The registered manager undertook audits to assess the continued safety of medication procedures.

Staff files we reviewed showed the registered manager completed recruitment procedures to verify they employed suitable staff. Records we looked at evidenced staff had a range of training and qualifications to underpin their knowledge and experience.

Care records we looked at held a variety of assessments and monitoring forms to mitigate the risks of malnutrition and dehydration. We observed staff offered choice at lunch and supported people, where applicable, discreetly and patiently.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. A visiting professional commented they observed staff were patient and gave people the time and basic information they needed to make decisions.

The registered manager went above and beyond to guide staff to people’s diverse needs and preferences about their culture and beliefs. Those who lived at Berwick and their relatives consistently commented about a kind and respectful team approach. One relative said, “The staff have such a loving attitude. They are like family.”

During our inspection, we saw staff sitting for long periods and engaging with people, talking quietly and reassuringly. A relative told us, “[My relative] loves it here. She is almost like another staff member in that she chats with the other residents and keeps them company. The staff really encourage that.” People and their relatives were at the heart of their care and fully involved in the development of their support plans.

We found each person’s documentation was personalised to their individual needs. Each care planned area included agreed goals to help people maximise their independence and life-skills.

Those who lived at Berwick and their relatives told us the home was well organised and had good leadership. We further noted everyone at the home was involved in its ongoing development. A relative commented, “[The registered manager] frequently asks me if there is anything else they could improve on.” The management team completed a range of audits to retain oversight of quality assurance, safet

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

We carried out this review to check whether Berwick House Rest Home had taken action in relation to: -

Outcome 5 – Meeting nutritional needs

Outcome 13 – Staffing

This was because the service was not compliant at the previous inspection.

We spoke with the registered manager and three staff. Because people who lived at the home had mental health conditions, we were unable to discuss care with them. We undertook a Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with people in their care. SOFI helps us assess and understand whether people who lived at the home were receiving the level of care that met their individual needs. This helped us to gain a balanced overview of what people experienced whilst living at the service.

We saw people were relaxed and happy during our inspection. The service had increased its staffing levels in the busy morning periods. This meant people were adequately supported to maintain their nutritional needs during breakfast. People were protected against unsafe care because the provider had increased staffing levels to meet their needs.

The inspection was led by one inspector. Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of the inspection visit we looked at how people were being cared for and supported. How the service ensured peoples nutritional needs were being met. We looked at what procedures were in place to ensure the service had effective infection control measures to protect people. We looked at how the service staffed the home. We did this to see how they responded to the needs of residents. Also to see if staff were employed in suitable numbers and had the knowledge and skills to provide care and support. We also looked at quality assurance systems to see how the service developed the services it provided to people.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, relatives and by looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Amber Court.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the staffing levels. Overall staffing levels met the needs of people using the service. However observations made during the breakfast period showed there were times when people waited for long periods for assistance with their meal. People were left unsupported to eat their meals. During the morning period staff were busy carrying out their duties, away from communal areas where most people spent their time. There was little engagement with people. This showed us the staffing levels during the morning period were inadequate to meet the needs of people.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Although there were no current applications in place, staff training had yet to be completed. However we saw this was planned for all staff so that they would understand when an application should be made and in how to submit one. This meant people would be safeguarded as required.

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the service effective?

We were told that each person’s health and care needs had been assessed prior to the service commencing. This was to make sure that the home could provide the level of care and support required. Records were available to support this.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. This included specialist nutrition such as prescribed supplements, which ensured people who were unable to take a normal diet received nutritional aids to meet their needs.

We noted there was a repellent odour in communal areas and some people’s bedrooms. Whist we saw evidence of regular carpet cleaning taking place every few days more needs to be done to eliminate the odour.

During the morning period we observed people were sat for long periods without any stimulation or activities provided to meet their needs. This was because staff on duty were carrying out their roles in other areas of the home.

Is the service caring?

People were seen to be supported by attentive and respectful staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff we spoke with told us it was a role they found rewarding. Comments included, “It’s a job I have done for some time now and really enjoy it”. Another told us, “I had never worked in care but I really enjoy my role here”.

People we spoke with during the inspection told us they were satisfied with the way their relatives were cared for. Comments included, “I don’t know how they do it but they are all very patient. I see that every time I come here”. Also, “They have done a really good job with my relative. It has really helped us as a family”.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Personal profiles had been developed by staff. Staff we spoke with told us this had helped them to understand things that were important with individual residents.

Is the service responsive?

The service had a range of activities in place to support people to undertake chosen interest. There was evidence of organised parties and events throughout the year which people told us they enjoyed. This had included a recent dancing with dementia day at Blackpool Tower Ballroom. Also, people had attended an armed forces day. Staff told us they were happy to come in and assist with special days out as it was a team effort and everyone got something out of it.

People using the home and their relatives or advocates had completed six monthly satisfaction surveys. The results were used to inform the development and quality of the service. Any issues highlighted were looked at and responded to in order to ensure the home was responding to the needs of people.

Is the service well led?

We saw there was evidence regular audits were taking place by looking at the systems and records in operation at the home. However there was no evidence to show how staffing levels were being monitored. By not doing so shortfalls noted during the morning period had not been identified by the provider. This had the potential to impact on the level of support available to people.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. They told us they felt supported by the manager and that they felt comfortable sharing any issues or concerns with them. They felt confident they would be listened to and action taken where necessary.

We received information that some people’s care needs were not being met having the potential to affect their wellbeing. Other information we received suggested staffing levels may be inappropriate to meet the needs of people living at Berwick House. Also, other information showed there may be lapses in staff training which had the potential to affect the health and safety of those using the service.

We shared this information with the local authority who visited the service to look at some of the issues. When we visited Berwick House we looked at records and spoke with the manager, four members of staff and a visitor. In addition we spoke with some of the people living at the home. People using the home had various levels of dementia therefore some of the communication was limited.

Records demonstrated the manager had reviewed all care planning records and made a number of changes in individual cases. We found routines were flexible and we witnessed staff treating people with sensitivity.

Staff told us staffing levels were generally suitable to meet peoples needs. One person told us, “We can be pushed sometimes but there is enough time to do our jobs as well as doing activities with residents”.

The manager was reviewing all systems in place but also taking account of the views of residents and relatives. A relative told us they were very happy with the care their relative received. “I come in most days and the girls are wonderful. My relative is very happy here”.

We spoke with a range of people about the home. They included the registered manager, staff members, some people who lived at the home and two visitors.

People living at this home had a range of dementia conditions. This affected how they communicated with us. For this reason we spent time in communal areas, so we could observe how the home was operating and how staff communicated and helped people.

We were told that the staff team were patient and kind. People also told us that they felt their relative was safe living at the home. One person said, “My relative has not been here for long but I think the staff are very attentive. The staff do very well”. Another relative told us, “They know how to manage the needs of mum”.

We observed the interaction between the staff and some of the people who used the service. We observed staff were respectful of people and treated them with dignity. For example, we saw staff sitting with people, talking with them sensitively and listening to what they were telling them. We also saw staff offer assistance with personal care needs in a discreet and dignified manner.

We gathered evidence for this review which included a site inspection on 16th May 2012. We also gathered evidence by talking to the manager, staff and other stakeholders of the service during that inspection.

Additional intelligence was gathered by looking at the informaiton we had recevied about the service. We used this to confirm how they had achieved compliance with staffing.

We visited this home unannounced on Wednesday 16th May 2012. During the course of the site inspection we spoke with the registered manager, some people living at the home, one visitor and a number of staff on duty.

People living at this home had a range of dementia conditions. This affected how they communicated with us. For this reason we spent time in communal areas, so we could observe how the home was operating and how staff communicated and helped people.

People we spoke with told us they were satisfied with the way the home provided care to their relatives. One person told us, "We have been very happy with they way they have cared for our relative.” Another person said, “Always helpful, they are always very polite.”

In addition to gaining the views and comments of people experiencing the service, we asked other external agencies including social services contracts team about their views of the home. They told us they have been monitoring the home and say it is improving its standards of care.

We spoke with a number of staff working in the home and they all demonstrated an awareness of the needs of people living there. Staff also spoke of the importance of treating people with respect and dignity. One staff member said, “It is important we get to know residents, because they all need different things.” A relative told us, "My family and I find this is a good home for our relative, they have a lovely room and the staff know what they are doing.”

We spoke to people about their experiences living in the home and were told the staff team provided them with personal care support and they felt well cared for.

People who use this service told us there wasn’t always enough staff on duty to meet their needs.

People told us staff were helpful and kind but they did not always have the time to talk to them.

"Beautiful staff, helpful and kind. I need help to go anywhere in my wheelchair. They are there to help".

“Staff could come and talk to you more and that would be nice. They seem to busy to stop to talk”. And "It's alright here but it's not home. Things could be better".